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Safety and Hemodynamic Effects of Pulmonary Angiography in Patients with Pulmonary Hypertension: 10-Year Single-Center Experience

¹ All authors: Division of Vascular and Interventional Radiology, Johns Hopkins Medical Institutions, 600 N Wolfe St., Blalock 545, Baltimore, MD 21287.

Abstract

OBJECTIVE. We sought to examine the incidence of complications and change in pulmonary artery pressure in patients with pulmonary hypertension who were undergoing pulmonary angiography.

MATERIALS AND METHODS. A retrospective review was performed for all patients who underwent pulmonary angiography over a 10-year period at a single institution. Patients with moderate pulmonary hypertension (pulmonary artery pressure, 30–59 mm Hg) and severe pulmonary hypertension (pulmonary artery pressure, 60 mm Hg) served as the study population. Demographic data, clinical indication, pre- and postcontrast pulmonary artery pressure measurements, type of pulmonary hypertension, contrast agent volume, complications, and American Society of Anesthesiologists (ASA) classification were recorded for all patients and compared.

RESULTS. Two hundred two of 612 patients who underwent pulmonary angiography had pulmonary hypertension. Moderate pulmonary hypertension was present in 155 patients (77%) and severe pulmonary hypertension, in 47 patients (23%). Three (2.0%) of four complications were fatal. The complication rate was higher in patients with severe pulmonary hypertension compared with patients with moderate pulmonary hypertension but not statistically significant (6.3% vs 0.6%, p = 0.63). Patients with complications had a higher mean ASA score than those without complications (4.0 vs 3.0, p = 0.03). Patients with lung transplants had the greatest increase in pulmonary artery pressure after pulmonary angiography compared with all other clinical indications (16.75 ± 12.97 mm Hg vs 5.46 ± 6.86 mm Hg, p = 0.003).

CONCLUSION. The complication rate of pulmonary angiography in patients with pulmonary hypertension is low. However, in severely ill patients with acute pulmonary hypertension, pulmonary angiography should be undertaken with extreme caution.

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